Top 5 Drugs That Cause Insomnia

Many drugs cause insomnia. What is most frustrating to me in my practice is when we start medications for a “new condition” prior to ruling out medication adverse effects. Here is the list of my top 5 drugs that cause insomnia (an important adverse effect that could show up on your board exam).

Corticosteroids. They are used for so many different conditions. Inflammatory disorders, pain, allergic reactions, and respiratory problems are a few examples where a steroid “burst” would be used for a period of a few days to a few weeks. It is incredibly important to ask patients who start a new medication for insomnia whether they have been on a steroid recently.

Systemic decongestants. Pseudoephedrine can be very effective at relieving nasal decongestion. Keep an eye out for patients who newly start this medication during cough and cold season, or possibly allergy season. Pseudoephedrine can definitely cause insomnia and contribute to polypharmacy.

Stimulants. Commonly used for attention disorders, stimulants like methylphenidate or amphetamine salts cause insomnia. Be sure you understand what type of stimulant the patient is taking and what time of the day they are taking it. Taking long-acting stimulants midday or later can cause significant insomnia. Many providers writing orders will recommend not taking any more stimulants in the early afternoon or later to avoid insomnia.

Caffeine. While not truly a medication, I’ve seen so many patients complain of insomnia but will ingest caffeinated beverages later in the day. You must ask patients who are reporting insomnia if they are using any caffeinated products and what time of the day they are using them.

Diuretics. While diuretics are not “stimulating” in nature, they do cause substantial diuresis. Patients taking diuretics may need to go to the bathroom more frequently than those not taking stimulants. Be sure to assess the timing of diuretic administration (give earlier in the day) and ensure that frequent urination isn’t the major contributing factor to insomnia.

Well, there you have, my top 5 drugs that cause insomnia. When someone asks you for an over-the-counter sleeper or is being dispensed a new prescription for zolpidem, I hope you find the time to ask a few questions and review the medication list to ensure we avoid the prescribing cascade. If you are looking for more education on polypharmacy and the prescribing cascade, be sure to check out one of my highest-rated books on this topic – Perils of Polypharmacy.

Did I miss any? Would you add other medications to the list of drugs that cause insomnia?

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